Results of combination anti-hypertensive therapy after failure of each of the components

B. J. Materson, D. J. Reda, W. C. Cushman, W. G. Henderson

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


We randomised ambulatory men with diastolic blood pressure (BP) 95-109 mm Hg without anti-hypertensive medication to single drug treatment with either hydrochlorothiazide 12.5-50 mg/day, atenolol 25-100 mg/day, captopril 25-100 mg/day, clonidine 0.2-0.6 mg/day, diltiazem-SR 120-360 mg/day, prazosin 4-20 mg/day or placebo in a double-blind prospective trial. The assigned drug was titrated to a goal BP of < 90 mm Hg. Patients not achieving goal BP were re-randomised to an alternative single active drug. Non-responders to the second drug received the first drug in combination with the second. Of the 102 non-responders to both drugs who qualified for the combination, 59 (57.8%) responded. The combination pairs that included a diuretic achieved diastolic goal BP in 69% and < 140 mm Hg systolic in 77% compared with 51% and 46%, respectively, for those combinations without a diuretic (P = 0.067; P = 0.002). Six of the eight terminations due to adverse drug reactions were in combinations containing prazosin; three of these six were hypotensive reactions. We conclude that two single drugs of insufficient efficacy to control BP individually have a high probability of achieving goal BP when combined, especially if the combination contains a diuretic.

Original languageEnglish (US)
Pages (from-to)791-796
Number of pages6
JournalJournal of human hypertension
Issue number10
StatePublished - Nov 10 1995


  • Atenolol
  • Captopril
  • Clonidine
  • Diltiazem
  • Hydrochlorothiazide
  • Monotherapy
  • Prazosin

ASJC Scopus subject areas

  • Internal Medicine


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